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Rescue supraglottic airway devices at caesarean delivery: What are the options to consider?

  • P. Wong
    Correspondence
    Corresponding author. Dr. P. Wong, Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore 16908
    Affiliations
    Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore
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  • B.L. Sng
    Affiliations
    Department of Women’s Anaesthesia, KK Women’s & Children’s Hospital, Singapore
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  • W.Y. Lim
    Correspondence
    Corresponding author. Dr. P. Wong, Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore 16908
    Affiliations
    Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore
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Published:November 18, 2019DOI:https://doi.org/10.1016/j.ijoa.2019.11.004

      Highlights

      • Obstetric difficult airway is associated with increased morbidity and mortality.
      • Supraglottic airway devices (SAD) allow rescue ventilation in obstetric patients.
      • Bronchoscopic intubation via a SAD has a high success rate.
      • Various obstetric factors determine whether to proceed with SAD guided intubation.

      Abstract

      Tracheal intubation is considered the gold standard means of securing the airway in obstetric general anaesthesia because of the increased risk of aspiration. Obstetric failed intubation is relatively rare. Difficult airway guidelines recommend the use of a supraglottic airway device to maintain the airway and to allow rescue ventilation. Failed intubation is associated with a further increased risk of aspiration, therefore there is an argument for performing supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI). The technique of SAGFBI has a high success rate in the non-obstetric population, it protects the airway and it minimises task fixation on repeated attempts at laryngoscopic tracheal intubation. However, after failed intubation via laryngoscopy, there is a lack of specific recommendations or indications for SAGFBI in current obstetric difficult airway guidelines in relation to achieving tracheal intubation.
      Our narrative review explores the issues pertaining to airway management in these cases: the use of supraglottic airway devices and the techniques of, and technical issues related to, SAGFBI. We also discuss the factors involved in the decision-making process as to whether to proceed with surgery with the airway maintained only with a supraglottic airway device, or to proceed only after SAGFBI.

      Keywords

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